Burden of Diabetes on the Ability to Work

Type 2 diabetes is an increasingly common disease (1) that places a considerable economic burden on society. An estimated 171 million people were suffering from diabetes in 2000, and this number could total 366 million by 2030 (1). Type 2 diabetes accounts for more than 90% of all diabetes cases, and it often appears in middle age (2). In 2010, the prevalence of diabetes in the U.S. was 11.3 and 26.9% among individuals aged 20 years or over and 65 years or older (2), respectively. In 2007, costs related to diabetes in the U.S. were an estimated $174 billion; $116 billion in direct costs and $58 billion in indirect costs (3). Direct costs include the cost of personal expenditures, drugs, and health care services, whereas indirect costs include lost productivity at work. Lost productivity at work may be measured through absenteeism (time lost from work due to illness), presenteeism (time at work impaired due to illness), productivity (time lost from work due to illness plus time at work impaired due to illness), or early retirement (retirement before the official retirement age due to illness). Lost productivity at work is an important concern for employees, employers, and society. Moreover, the complications related to diabetes are a major cause of disability, reduced quality of life, and death (4). Employees with diabetes may stop working prematurely (5–8) and may experience unemployment (7,9–12), which could translate into a reduction in earned income and savings (13) and loss of self-esteem (14). For employers too, lost productivity due to absenteeism (6,8,13,15–23), presenteeism (17), and early retirement (5–7) is an important economic issue. To the best of our knowledge, there are no published systematic reviews answering the following question: Do individuals with diabetes have more time lost from work or more impaired time at work, and do they retire earlier than individuals without diabetes? Knowledge synthesis is needed regarding the effect of type 2 diabetes on a person’s ability to work so as to improve our understanding of the indirect impact of this chronic disease, to provide evidence for the importance of addressing its effects on the workforce, and to develop and implement sound interventions specifically designed for workers with diabetes. The aim of this study was to perform a systematic review in order to describe the risk and magnitude of lost productivity due to absenteeism, presenteeism, and early retirement among individuals with type 2 diabetes in the workforce compared with those without the disease.